Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty

Sanjay V. Patel, David O. Hodge, William M. Bourne, John D. Gottsch, Dan B. Jones, Jules L. Baum, Ivan R. Schwab, Woody S. Vanmeter, John T. Flynn, Jacob T. Wilensky, Sanjay V. Patel

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine changes in the central endothelium and thickness of grafted corneas, and the cumulative probability of developing glaucoma, graft rejection, and graft failure 15 years after penetrating keratoplasty. Methods: In a longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon, regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness by using specular microscopy. The presence of glaucoma, graft rejection, and graft failure was recorded. Results: The 67 patients examined at 15 years represented 30% of the available clear grafts (107 patients had died, 76 grafts had failed). Endothelial cell loss from preoperative donor levels was 71 ± 12% (mean ± SD, n = 67), endothelial cell density was 872 ± 348 cells/mm2, and corneal thickness was 0.59 ± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years (minimum detectable difference was 96 cells/mm2, α = .05, β = .20, n =54), whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 ± 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and six of the eight graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.

Original languageEnglish (US)
Pages (from-to)57-66
Number of pages10
JournalTransactions of the American Ophthalmological Society
Volume102
StatePublished - 2004

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Corneal Endothelium
Penetrating Keratoplasty
Transplants
Endothelial Cells
Graft Rejection
Glaucoma
Cornea
Cell Count
Endothelium
Longitudinal Studies
Microscopy
Cohort Studies
Tissue Donors

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Patel, S. V., Hodge, D. O., Bourne, W. M., Gottsch, J. D., Jones, D. B., Baum, J. L., ... Patel, S. V. (2004). Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Transactions of the American Ophthalmological Society, 102, 57-66.

Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. / Patel, Sanjay V.; Hodge, David O.; Bourne, William M.; Gottsch, John D.; Jones, Dan B.; Baum, Jules L.; Schwab, Ivan R.; Vanmeter, Woody S.; Flynn, John T.; Wilensky, Jacob T.; Patel, Sanjay V.

In: Transactions of the American Ophthalmological Society, Vol. 102, 2004, p. 57-66.

Research output: Contribution to journalArticle

Patel, SV, Hodge, DO, Bourne, WM, Gottsch, JD, Jones, DB, Baum, JL, Schwab, IR, Vanmeter, WS, Flynn, JT, Wilensky, JT & Patel, SV 2004, 'Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty', Transactions of the American Ophthalmological Society, vol. 102, pp. 57-66.
Patel, Sanjay V. ; Hodge, David O. ; Bourne, William M. ; Gottsch, John D. ; Jones, Dan B. ; Baum, Jules L. ; Schwab, Ivan R. ; Vanmeter, Woody S. ; Flynn, John T. ; Wilensky, Jacob T. ; Patel, Sanjay V. / Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. In: Transactions of the American Ophthalmological Society. 2004 ; Vol. 102. pp. 57-66.
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abstract = "Purpose: To determine changes in the central endothelium and thickness of grafted corneas, and the cumulative probability of developing glaucoma, graft rejection, and graft failure 15 years after penetrating keratoplasty. Methods: In a longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon, regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness by using specular microscopy. The presence of glaucoma, graft rejection, and graft failure was recorded. Results: The 67 patients examined at 15 years represented 30{\%} of the available clear grafts (107 patients had died, 76 grafts had failed). Endothelial cell loss from preoperative donor levels was 71 ± 12{\%} (mean ± SD, n = 67), endothelial cell density was 872 ± 348 cells/mm2, and corneal thickness was 0.59 ± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years (minimum detectable difference was 96 cells/mm2, α = .05, β = .20, n =54), whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 ± 5.7{\%} (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20{\%}, 23{\%}, and 28{\%}, respectively, and six of the eight graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.",
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T1 - Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty

AU - Patel, Sanjay V.

AU - Hodge, David O.

AU - Bourne, William M.

AU - Gottsch, John D.

AU - Jones, Dan B.

AU - Baum, Jules L.

AU - Schwab, Ivan R.

AU - Vanmeter, Woody S.

AU - Flynn, John T.

AU - Wilensky, Jacob T.

AU - Patel, Sanjay V.

PY - 2004

Y1 - 2004

N2 - Purpose: To determine changes in the central endothelium and thickness of grafted corneas, and the cumulative probability of developing glaucoma, graft rejection, and graft failure 15 years after penetrating keratoplasty. Methods: In a longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon, regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness by using specular microscopy. The presence of glaucoma, graft rejection, and graft failure was recorded. Results: The 67 patients examined at 15 years represented 30% of the available clear grafts (107 patients had died, 76 grafts had failed). Endothelial cell loss from preoperative donor levels was 71 ± 12% (mean ± SD, n = 67), endothelial cell density was 872 ± 348 cells/mm2, and corneal thickness was 0.59 ± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years (minimum detectable difference was 96 cells/mm2, α = .05, β = .20, n =54), whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 ± 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and six of the eight graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.

AB - Purpose: To determine changes in the central endothelium and thickness of grafted corneas, and the cumulative probability of developing glaucoma, graft rejection, and graft failure 15 years after penetrating keratoplasty. Methods: In a longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon, regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness by using specular microscopy. The presence of glaucoma, graft rejection, and graft failure was recorded. Results: The 67 patients examined at 15 years represented 30% of the available clear grafts (107 patients had died, 76 grafts had failed). Endothelial cell loss from preoperative donor levels was 71 ± 12% (mean ± SD, n = 67), endothelial cell density was 872 ± 348 cells/mm2, and corneal thickness was 0.59 ± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years (minimum detectable difference was 96 cells/mm2, α = .05, β = .20, n =54), whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 ± 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and six of the eight graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.

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